Written evidence from James Tudor-White1 (RCC 07) Public Administration and Constitutional Affairs Committee Responding to Covid-19 and the Coronavirus Act inquiry SUMMARISATION The Covid-19 pandemic caught the world by surprise in early 2020, and we are still by no means close to having found a solution to the pandemic. While the "situation in Europe is improving, globally it is worsening" (World Health Organisation, 2020, p.1). The Coronavirus Act 2020 was implemented to provide the government with the powers necessary to be able to tackle and handle the pandemic. In April, the government outlined its 5 tests for determining when lockdown measures could and should be lifted. These measures will also play an important determinant on whether to end the temporary provisions of the Coronavirus Act of 2020. The ultimate goal is that Covid-19 will no longer pose a threat to the population of the United Kingdom. Once this is the case, there would be no reason for the government to possess any of the temporary powers it was given as a result of this piece of legislation. Each test the government laid out will have its own advantages and caveats when determining the duration of the lockdown and when the temporary provisions of the Coronavirus Act 2020 can be repealed. The National Health Service being overwhelmed by the coronavirus outbreak was a major concern, and still is a concern for any future planning. This test is a good benchmark for determining whether the United Kingdom could handle another significant outbreak of Covid-19. It is widely accepted that this is likely to be the case, and it should be viewed as a case of when, not if. The capacity of the NHS will be instrumental in determining the response to any further outbreaks of Covid-19, and this will be determined by ensuring there is sufficient PPE, critical care capacity, and low staff sickness levels. Relieving of lockdown measures and the rescinding of the Coronavirus Act 2020 should also be determined by the Ro rate and the rate of infection. It will also require a global outlook however, because of the nature that pandemics often occur over several waves, thus increases in the rate of infections in other countries which have already been affected by the pandemic could act as a lead indicator of what the UK should expect. As part of devolution the nations of Northern Ireland, Scotland and Wales all have the powers to determine healthcare policy. Therefore, there is definitely the capabilities and scope for divergence in policies between the four nations. This report goes on to further state that localised responses to 1 James Tudor-White Esq. is an International Relations major from the University of Birmingham. Since March, James has been following the coronavirus pandemic engaging with a variety of experts from a variety of organisations, as well as reading relevant academic literature on the subject. coronavirus will be the best approach, and if not localised then certainly the devolved powers should be able to decide the best approach. I do suggest that despite a localised approach being the best response there should be some central authoritative oversight when it comes to collating data and setting the standards and overall numbers of testing required. It will then be down to each nation to determine which regions need the most testing. To what extent should the Government's five tests for easing lockdown also inform whether to end the temporary provisions of the Coronavirus Act 2020? How should the 5 tests be evidenced? In April, it was announced the lockdown of the United Kingdom would end when 5 criterions were met, to ensure a handle had been reached on the coronavirus crisis. It is imperative that the easing of lockdown measures should be slow and transitional. The Ro rate must be the clear determinant of easing lockdown measures and any relieving of measures which could increase the Ro rate above one must not proceed despite any public or media pressure. It is essential scientific evidence prevails. At the time of writing this evidence, the UK is beginning to 'open up' and non- essential retail shops are expected to open on the 15th of June. It is very easy to be hasty when making amendments or considering the ending of the temporary provisions bestowed on the government by the Coronavirus Act of 2020, but concern and preparedness should be focused on making sure there are sufficient measures in place if there is to be a second peak epidemic. Any delay in the response could ultimately lead to unnecessary loss of life, and therefore it may be in the best interests, to ensure that the ability to implement the temporary measures at short notice is still easily possible. Test 1 - THE NATIONAL HEALTH SERVICE MUST NOT BE OVERWHELMED During the previous months of the coronavirus crisis there were serious and very valid concerns that the National Health Service could be overwhelmed. This led to the rapid establishment of NHS Nightingale hospitals, designed to increase capacity either for the treatment of Covid-19 patients or as 'step-down' facilities for recuperation and those not requiring treatment using ventilators. Thankfully, many of these facilities accepted none or fewer than anticipated patients, and therefore these facilities were not overwhelmed. However, it would be wrong to categorically say that the NHS was not at stages overwhelmed, and this must be considered on a local and regional level. It was well publicised and documented the strains the NHS staff were under, and the pressures on hospitals, especially in regard to Personal Protective Equipment (PPE). Northwick Park hospital in North London declared a critical emergency where it had to ask local hospitals to take some of their patients, for they were lacking spaces to provide critical and intensive care as a result of the increasing number of Covid-19 patients (Dunhill, 2020). Finding evidence for this test should be one of the easiest. Evidence can be gathered directly from hospital trusts and from a regional health authority level. This would be the most appropriate way of identifying strains on the NHS. Another determinant of ensuring whether the NHS could become overwhelmed would be to establish what the Ro rate is currently at and make any forecasts 1 as to predict how it could change. If it is likely to increase significantly above 1, then assurances should be sort that the expected number of those infected with Covid-19 requiring hospitalisation would not be greater than the current capacity, i.e. social shielding of the most vulnerable is in place so severity of Covid-19 infections is minimised as much as possible. If it were to be greater, then measures such as reintroducing some aspects of the lockdown measures should be considered, so as to reduce the Ro rate below 1 to stop the spread of the virus accelerating. I personally believe and will repeat this assertion, that a regional approach will be the most effective means of managing the relief of lockdown measures, gathering evidence necessary for the monitoring of the Covid-19 outbreak, and ultimately on determining whether there should be any reintroduction of lockdown measures. Hospital trusts and regional health authorities will have the best understanding of the current situation in their hospitals and health care facilities (including care homes and hospices) and will be best to realise any challenges or shortcomings these facilities may face, that a centralised governmental response could overlook. TEST 2 - A 'SUSTAINED AND CONSISTENT' DECREASE IN THE DAILY DEATH RATE It is imperative that any 'sustained and consistent' decrease in the daily death rate is not just relative to the infection rate. Logic dictates that if the number of confirmed active cases falls, then the death rate will also decrease. What the government needs to ensure is happening, especially as further research is conducted on potential treatments and alleviants, is that the death rate is falling compared to previous months. i.e. the number of people who die from Covid-19 in July is less than in June even if the number of people infected remains the same. Otherwise, [with the evidence and knowledge of Covid-19 we have at the time - in which there is no definitive answer as to whether immunity exists] we could enter a new second peak epidemic, in which there could be a significant number of fatalities. What needs to be ensured is that should the rate of infection rises, as it very well could when all social distancing measures are reversed, sufficient and adequate healthcare should be available to ensure the death rate remains low and does not rise. Dexamethasone is a significant leap forward in this direction. This test I believe is one of the easiest to measure, the data can be collated from death certificates. I believe an important aspect of this would be that there should be greater consideration on deaths which can also be attributed to Covid-19. Another aspect of data which should be considered is the excess mortality rate, this will help provide a detailed understanding of what the death rate is like across the country, in which demographics are suffering from the greatest excess mortalities. TEST 3 -RATE OF INFECTION HAS DECREASED TO 'MANAGEABLE LEVELS' This also appears to be a test which can be easily met, when test and trace has been fully implemented. The rate of infection will naturally decrease as people remain isolated from one another during the lockdown and the mode of transmission of the virus reduces. What needs to be ensured is that the rate of infection is at a low level but also the number of confirmed and suspected cases are at low levels.